<?=$this->load->view('include_header',null)?>
<style type="text/css">
form#form input {
	padding:8px;
	margin-bottom:0px;
	_width:expression(type=="text"?60:style);
}

form#form input[type="text"]
{
 width:60px;
} 
select { width:80px;}
</style>
	<div id="top-panel">
		<div id="panel">
			<ul>
				<li class="current"><a href="<?=site_url('archive/idcard/'.$id)?>" class="report"><?=(empty($id))?"录入新":"编辑"?>客户基本信息</a></li>
				<?php if(!empty($info->id)):?><li><a id="printInfo" class="folder_table">打印本页信息</a></li><?php endif;?>
			</ul>
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	<div id="wrapper">
		<div id="content">
			<div id="box">
<!-- table begin -->
<form method="post" id="form"  enctype="multipart/form-data" action="<?=site_url('schengen/au_family_update/'.$cateid)?>">

	<h3>澳大利亚家庭構成表/Family composition[54]</h3>
    <table width="100%">
    
    <tfoot>
        <tr>
            <td colspan="7" align="right">			
			<input type="hidden" name="id" value="<?=$id?>" />
			<input id="button1" type="submit" value="提交信息" />
			<input id="button2" type="reset" value="重置" />			</td>
        </tr>
    </tfoot>

    <tbody>
		<tr class="odd">
            <td colspan="2">你想申請下列何種簽証﹖</td>
        	<td colspan="2"><input type="radio" name="cn_app_type" value="1" <?= (@$info->cn_app_type==1)?'checked':''?> />旅遊 (676)<br />
        		<input type="radio" name="cn_app_type" value="2" <?= (@$info->cn_app_type==2)?'checked':''?> />家庭擔保訪問 (679)<br />
        		<input type="radio" name="cn_app_type" value="3" <?= (@$info->cn_app_type==3)?'checked':''?> />商務短期訪問 (456)<br />
        		<input type="radio" name="cn_app_type" value="4" <?= (@$info->cn_app_type==4)?'checked':''?> />其它</td>
        	<td colspan="3">1. 你只能用英文填寫此表。<br />
        		2. 你必須填寫你在原籍國和外國的所有家庭成員的細節，其中包括同父異母（或同母異父）的兄弟姐妹和子女，繼父與其前妻（或繼母與其前
        		夫）所生的兄弟姐妹和子女，領養的兄弟姐妹和子女。（如果人已不在世，可在“家庭地址”一欄填上“已故”。如果去向不明，可在“家
        		庭地址”一欄填上“不知道”。<br />
        		3. 你填寫此表時如果有人協助，你只能在所填資料真實和正確，而且你完全知道﹑同意並理解資料的填入的情況下，才能在宣誓一欄下籤字。</td>
			</tr>
        <tr class="even" align="center">
            <td>家庭<br />構成</td>
        	<td>姓</td>
        	<td>名</td>
        	<td>出生
        		<hr />
        		日 月 年</td>
			<td>婚戀狀況<br />
				（請使用下表的代碼）</td>
			<td>家庭地址</td>
			<td>以前是否來過澳大利亞﹖
				<hr />
				日 月 年</td>
        </tr>
		<tr class="odd">
            <td>你本人</td>
        	<td><input type="text" name="cn_r1_c1" value="<?= @$info->cn_r1_c1?>"/></td>
        	<td><input type="text" name="cn_r1_c2" value="<?= @$info->cn_r1_c2?>"/></td>
        	<td nowrap="nowrap"><input type="text" name="cn_r1_c3" id="cn_r1_c3" value="<?= @$info->cn_r1_c3?>"/></td>
			<td><select name="cn_r1_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r1_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r1_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r1_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r1_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r1_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r1_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r1_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r1_c5" value="<?= @$info->cn_r1_c5?>" style="width:150px"/></td>
			<td nowrap="nowrap"><input type="text" name="cn_r1_c6" id="cn_r1_c6" value="<?= @$info->cn_r1_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>配偶</td>
        	<td><input type="text" name="cn_r2_c1" value="<?= @$info->cn_r2_c1?>"/></td>
        	<td><input type="text" name="cn_r2_c2" value="<?= @$info->cn_r2_c2?>"/></td>
        	<td><input type="text" name="cn_r2_c3" id="cn_r2_c3" value="<?= @$info->cn_r2_c3?>"/></td>
			<td><select name="cn_r2_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r2_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r2_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r2_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r2_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r2_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r2_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r2_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r2_c5" value="<?= @$info->cn_r2_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r2_c6" id="cn_r2_c6" value="<?= @$info->cn_r2_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>事實婚姻</td>
        	<td><input type="text" name="cn_r3_c1" value="<?= @$info->cn_r3_c1?>"/></td>
        	<td><input type="text" name="cn_r3_c2" value="<?= @$info->cn_r3_c2?>"/></td>
        	<td><input type="text" name="cn_r3_c3" id="cn_r3_c3" value="<?= @$info->cn_r3_c3?>"/></td>
			<td><select name="cn_r3_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r3_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r3_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r3_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r3_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r3_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r3_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r3_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r3_c5" value="<?= @$info->cn_r3_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r3_c6" id="cn_r3_c6" value="<?= @$info->cn_r3_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>父親/母親</td>
        	<td><input type="text" name="cn_r4_c1" value="<?= @$info->cn_r4_c1?>"/></td>
        	<td><input type="text" name="cn_r4_c2" value="<?= @$info->cn_r4_c2?>"/></td>
        	<td><input type="text" name="cn_r4_c3" id="cn_r4_c3" value="<?= @$info->cn_r4_c3?>"/></td>
			<td><select name="cn_r4_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r4_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r4_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r4_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r4_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r4_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r4_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r4_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r4_c5" value="<?= @$info->cn_r4_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r4_c6" id="cn_r4_c6" value="<?= @$info->cn_r4_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>父親/母親</td>
        	<td><input type="text" name="cn_r5_c1" value="<?= @$info->cn_r5_c1?>"/></td>
        	<td><input type="text" name="cn_r5_c2" value="<?= @$info->cn_r5_c2?>"/></td>
        	<td><input type="text" name="cn_r5_c3" id="cn_r5_c3" value="<?= @$info->cn_r5_c3?>"/></td>
			<td><select name="cn_r5_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r5_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r5_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r5_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r5_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r5_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r5_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r5_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r5_c5" value="<?= @$info->cn_r5_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r5_c6" id="cn_r5_c6" value="<?= @$info->cn_r5_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>兄弟/姐妹</td>
        	<td><input type="text" name="cn_r6_c1" value="<?= @$info->cn_r6_c1?>"/></td>
        	<td><input type="text" name="cn_r6_c2" value="<?= @$info->cn_r6_c2?>"/></td>
        	<td><input type="text" name="cn_r6_c3" id="cn_r6_c3" value="<?= @$info->cn_r6_c3?>"/></td>
			<td><select name="cn_r6_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r6_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r6_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r6_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r6_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r6_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r6_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r6_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r6_c5" value="<?= @$info->cn_r6_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r6_c6" id="cn_r6_c6" value="<?= @$info->cn_r6_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>兄弟/姐妹</td>
        	<td><input type="text" name="cn_r7_c1" value="<?= @$info->cn_r7_c1?>"/></td>
        	<td><input type="text" name="cn_r7_c2" value="<?= @$info->cn_r7_c2?>"/></td>
        	<td><input type="text" name="cn_r7_c3" id="cn_r7_c3" value="<?= @$info->cn_r7_c3?>"/></td>
			<td><select name="cn_r7_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r7_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r7_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r7_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r7_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r7_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r7_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r7_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r7_c5" value="<?= @$info->cn_r7_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r7_c6" id="cn_r7_c6" value="<?= @$info->cn_r7_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>兄弟/姐妹</td>
        	<td><input type="text" name="cn_r8_c1" value="<?= @$info->cn_r8_c1?>"/></td>
        	<td><input type="text" name="cn_r8_c2" value="<?= @$info->cn_r8_c2?>"/></td>
        	<td><input type="text" name="cn_r8_c3" id="cn_r8_c3" value="<?= @$info->cn_r8_c3?>"/></td>
			<td><select name="cn_r8_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r8_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r8_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r8_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r8_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r8_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r8_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r8_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r8_c5" value="<?= @$info->cn_r8_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r8_c6" id="cn_r8_c6" value="<?= @$info->cn_r8_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>兒子/女兒</td>
        	<td><input type="text" name="cn_r9_c1" value="<?= @$info->cn_r9_c1?>"/></td>
        	<td><input type="text" name="cn_r9_c2" value="<?= @$info->cn_r9_c2?>"/></td>
        	<td><input type="text" name="cn_r9_c3" id="cn_r9_c3" value="<?= @$info->cn_r9_c3?>"/></td>
			<td><select name="cn_r9_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r9_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r9_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r9_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r9_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r9_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r9_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r9_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r9_c5" value="<?= @$info->cn_r9_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r9_c6" id="cn_r9_c6" value="<?= @$info->cn_r9_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>兒子/女兒</td>
        	<td><input type="text" name="cn_r10_c1" value="<?= @$info->cn_r10_c1?>"/></td>
        	<td><input type="text" name="cn_r10_c2" value="<?= @$info->cn_r10_c2?>"/></td>
        	<td><input type="text" name="cn_r10_c3" id="cn_r10_c3" value="<?= @$info->cn_r10_c3?>"/></td>
			<td><select name="cn_r10_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r10_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r10_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r10_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r10_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r10_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r10_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r10_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r10_c5" value="<?= @$info->cn_r10_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r10_c6" id="cn_r10_c6" value="<?= @$info->cn_r10_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>兒子/女兒</td>
        	<td><input type="text" name="cn_r11_c1" value="<?= @$info->cn_r11_c1?>"/></td>
        	<td><input type="text" name="cn_r11_c2" value="<?= @$info->cn_r11_c2?>"/></td>
        	<td><input type="text" name="cn_r11_c3" id="cn_r11_c3" value="<?= @$info->cn_r11_c3?>"/></td>
			<td><select name="cn_r11_c4">
				<option></option>	
				<option value="M" <?= (@$info->cn_r11_c4=='M')?'selected':''?>>已婚</option>
				<option value="E" <?= (@$info->cn_r11_c4=='E')?'selected':''?>>訂婚</option>
				<option value="F" <?= (@$info->cn_r11_c4=='F')?'selected':''?>>事實婚姻</option>
				<option value="S" <?= (@$info->cn_r11_c4=='S')?'selected':''?>>分居</option>
				<option value="D" <?= (@$info->cn_r11_c4=='D')?'selected':''?>>離婚</option>
				<option value="W" <?= (@$info->cn_r11_c4=='W')?'selected':''?>>寡/鰥</option>
				<option value="N" <?= (@$info->cn_r11_c4=='N')?'selected':''?>>未婚或未有過事實婚姻</option>
			</select></td>
			<td><input type="text" name="cn_r11_c5" value="<?= @$info->cn_r11_c5?>" style="width:150px"/></td>
			<td><input type="text" name="cn_r11_c6" id="cn_r11_c6" value="<?= @$info->cn_r11_c6?>"/></td>
        </tr>
        <tr class="even">
            <td colspan="2">“婚戀狀況”代碼<br />
            	M = 已婚<br />
            	E = 訂婚<br />
            	F = 事實婚姻<br />
            	S = 分居<br />
            	D = 離婚<br />
            	W = 寡/鰥<br />
            	N = 未婚或未有過事實婚姻</td>
        	<td colspan="3">宣誓<br />
        		我特此宣誓﹕<br />
        		• 本表中填寫的資料完整而正確<br />
        		• 在他人協助下填寫的本表任何部份的資料都是真實和
        		正確的﹐而且我完全知道﹑同意並理解資料的填入。</td>
        	<td>申請人簽名<br />
        		日月 年<br />
        		<input type="text" name="cn_applicant_date" id="cn_applicant_date" value="<?= @$info->cn_applicant_date?>"/></td>
			<td>見證人簽名<br />
				日月 年<br />
				<input type="text" name="cn_witness_date" id="cn_witness_date" value="<?= @$info->cn_witness_date?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="7">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="2">Are you applying for a:</td>
        	<td colspan="2">
			<input type="radio" name="en_app_type" value="1" <?= (@$info->en_app_type==1)?'checked':''?> />Tourist visa (676)<br />
        	<input type="radio" name="en_app_type" value="2" <?= (@$info->en_app_type==2)?'checked':''?> />Sponsored family visitor (679)<br />
        	<input type="radio" name="en_app_type" value="3" <?= (@$info->en_app_type==3)?'checked':''?> />Business short stay (456)<br />
        	<input type="radio" name="en_app_type" value="4" <?= (@$info->en_app_type==4)?'checked':''?> />Other</td>
        	<td colspan="3">1. You must complete this form in English only.<br />
        		2. You must give details of all your family members living in your home country and abroad including half, step and adopted brothers, sisters and children
        		(if not living, write ‘Deceased’ in Home address column. If whereabouts unknown, write ‘Unknown’ in Home address column).<br />
        		3. If you have been assisted in completing this form, you should only sign the Declaration if the information is true and correct and has been included with
        		your full knowledge, consent and understanding.</td>
			</tr>
		<tr class="odd" align="center">
            <td>Family<br />
            	composition</td>
        	<td>Family name</td>
        	<td>Given names</td>
			<td>Date of birth
				<hr />
				DAY MONTH YEAR</td>
			<td>Relationship status<br />
				(use codes below)</td>
			<td>Home address</td>
			<td>Previous visits to Australia
				<hr />
				DAY MONTH YEAR</td>
        </tr>
        <tr class="even">
            <td>Yourself</td>
        	<td><input type="text" name="en_r1_c1" value="<?= @$info->en_r1_c1?>"/></td>
        	<td><input type="text" name="en_r1_c2" value="<?= @$info->en_r1_c2?>"/></td>
        	<td><input type="text" name="en_r1_c3" id="en_r1_c3" value="<?= @$info->en_r1_c3?>"/></td>
			<td><select name="en_r1_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r1_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r1_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r1_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r1_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r1_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r1_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r1_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r1_c5" value="<?= @$info->en_r1_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r1_c6" id="en_r1_c6" value="<?= @$info->en_r1_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>Spouse</td>
        	<td><input type="text" name="en_r2_c1" value="<?= @$info->en_r2_c1?>"/></td>
        	<td><input type="text" name="en_r2_c2" value="<?= @$info->en_r2_c2?>"/></td>
        	<td><input type="text" name="en_r2_c3" id="en_r2_c3" value="<?= @$info->en_r2_c3?>"/></td>
			<td><select name="en_r2_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r2_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r2_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r2_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r2_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r2_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r2_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r2_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r2_c5" value="<?= @$info->en_r2_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r2_c6" id="en_r2_c6" value="<?= @$info->en_r2_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>De facto</td>
        	<td><input type="text" name="en_r3_c1" value="<?= @$info->en_r3_c1?>"/></td>
        	<td><input type="text" name="en_r3_c2" value="<?= @$info->en_r3_c2?>"/></td>
        	<td><input type="text" name="en_r3_c3" id="en_r3_c3" value="<?= @$info->en_r3_c3?>"/></td>
			<td><select name="en_r3_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r3_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r3_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r3_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r3_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r3_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r3_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r3_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r3_c5" value="<?= @$info->en_r3_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r3_c6" id="en_r3_c6" value="<?= @$info->en_r3_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>Father/Mother</td>
        	<td><input type="text" name="en_r4_c1" value="<?= @$info->en_r4_c1?>"/></td>
        	<td><input type="text" name="en_r4_c2" value="<?= @$info->en_r4_c2?>"/></td>
        	<td><input type="text" name="en_r4_c3" id="en_r4_c3" value="<?= @$info->en_r4_c3?>"/></td>
			<td><select name="en_r4_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r4_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r4_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r4_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r4_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r4_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r4_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r4_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r4_c5" value="<?= @$info->en_r4_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r4_c6" id="en_r4_c6" value="<?= @$info->en_r4_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>Father/Mother</td>
        	<td><input type="text" name="en_r5_c1" value="<?= @$info->en_r5_c1?>"/></td>
        	<td><input type="text" name="en_r5_c2" value="<?= @$info->en_r5_c2?>"/></td>
        	<td><input type="text" name="en_r5_c3" id="en_r5_c3" value="<?= @$info->en_r5_c3?>"/></td>
			<td><select name="en_r5_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r5_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r5_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r5_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r5_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r5_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r5_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r5_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r5_c5" value="<?= @$info->en_r5_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r5_c6" id="en_r5_c6" value="<?= @$info->en_r5_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>Brother/sister</td>
        	<td><input type="text" name="en_r6_c1" value="<?= @$info->en_r6_c1?>"/></td>
        	<td><input type="text" name="en_r6_c2" value="<?= @$info->en_r6_c2?>"/></td>
        	<td><input type="text" name="en_r6_c3" id="en_r6_c3" value="<?= @$info->en_r6_c3?>"/></td>
			<td><select name="en_r6_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r6_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r6_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r6_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r6_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r6_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r6_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r6_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r6_c5" value="<?= @$info->en_r6_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r6_c6" id="en_r6_c6" value="<?= @$info->en_r6_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>Brother/sister</td>
        	<td><input type="text" name="en_r7_c1" value="<?= @$info->en_r7_c1?>"/></td>
        	<td><input type="text" name="en_r7_c2" value="<?= @$info->en_r7_c2?>"/></td>
        	<td><input type="text" name="en_r7_c3" id="en_r7_c3" value="<?= @$info->en_r7_c3?>"/></td>
			<td><select name="en_r7_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r7_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r7_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r7_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r7_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r7_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r7_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r7_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r7_c5" value="<?= @$info->en_r7_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r7_c6" id="en_r7_c6" value="<?= @$info->en_r7_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>Brother/sister</td>
        	<td><input type="text" name="en_r8_c1" value="<?= @$info->en_r8_c1?>"/></td>
        	<td><input type="text" name="en_r8_c2" value="<?= @$info->en_r8_c2?>"/></td>
        	<td><input type="text" name="en_r8_c3" id="en_r8_c3" value="<?= @$info->en_r8_c3?>"/></td>
			<td><select name="en_r8_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r8_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r8_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r8_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r8_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r8_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r8_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r8_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r8_c5" value="<?= @$info->en_r8_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r8_c6" id="en_r8_c6" value="<?= @$info->en_r8_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>Son/daughter</td>
        	<td><input type="text" name="en_r9_c1" value="<?= @$info->en_r9_c1?>"/></td>
        	<td><input type="text" name="en_r9_c2" value="<?= @$info->en_r9_c2?>"/></td>
        	<td><input type="text" name="en_r9_c3" id="en_r9_c3" value="<?= @$info->en_r9_c3?>"/></td>
			<td><select name="en_r9_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r9_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r9_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r9_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r9_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r9_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r9_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r9_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r9_c5" value="<?= @$info->en_r9_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r9_c6" id="en_r9_c6" value="<?= @$info->en_r9_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td>Son/daughter</td>
        	<td><input type="text" name="en_r10_c1" value="<?= @$info->en_r10_c1?>"/></td>
        	<td><input type="text" name="en_r10_c2" value="<?= @$info->en_r10_c2?>"/></td>
        	<td><input type="text" name="en_r10_c3" id="en_r10_c3" value="<?= @$info->en_r10_c3?>"/></td>
			<td><select name="en_r10_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r10_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r10_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r10_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r10_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r10_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r10_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r10_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r10_c5" value="<?= @$info->en_r10_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r10_c6" id="en_r10_c6" value="<?= @$info->en_r10_c6?>"/></td>
        </tr>
        <tr class="even">
            <td>Son/daughter</td>
        	<td><input type="text" name="en_r11_c1" value="<?= @$info->en_r11_c1?>"/></td>
        	<td><input type="text" name="en_r11_c2" value="<?= @$info->en_r11_c2?>"/></td>
        	<td><input type="text" name="en_r11_c3" id="en_r11_c3" value="<?= @$info->en_r11_c3?>"/></td>
			<td><select name="en_r11_c4">
				<option></option>	
				<option value="M" <?= (@$info->en_r11_c4=='M')?'selected':''?>>Married</option>
				<option value="E" <?= (@$info->en_r11_c4=='E')?'selected':''?>>Engaged</option>
				<option value="F" <?= (@$info->en_r11_c4=='F')?'selected':''?>>De facto</option>
				<option value="S" <?= (@$info->en_r11_c4=='S')?'selected':''?>>Separated</option>
				<option value="D" <?= (@$info->en_r11_c4=='D')?'selected':''?>>Divorced</option>
				<option value="W" <?= (@$info->en_r11_c4=='W')?'selected':''?>>Widowed</option>
				<option value="N" <?= (@$info->en_r11_c4=='N')?'selected':''?>>Never married or been in a de facto relationship</option>
			</select></td>
			<td><input type="text" name="en_r11_c5" value="<?= @$info->en_r11_c5?>" style="width:150px"/></td>
			<td><input type="text" name="en_r11_c6" id="en_r11_c6" value="<?= @$info->en_r11_c6?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="2">‘Relationship status’ codes<br />
            	M = Married<br />
            	E = Engaged<br />
            	F = De facto<br />
            	S = Separated<br />
            	D = Divorced<br />
            	W = Widowed<br />
            	N = Never married or been in<br />
            	a de facto relationship</td>
        	<td colspan="3">Declaration<br />
        		I declare that:<br />
        		• the information I have given on this form is complete and correct.<br />
        		• in any section of this form which has been completed with the
        		assistance of another person, the information as set down is
        		true and correct and has been included with my full knowledge,
        		consent and understanding.</td>
        	<td>Signature of applicant<br />
        		DAY MONTH YEAR<br />
        		<input type="text" name="en_applicant_date" id="en_applicant_date" value="<?= @$info->en_applicant_date?>"/></td>
			<td>Signature of witness<br />
				DAY MONTH YEAR<br />
				<input type="text" name="en_witness_date" id="en_witness_date" value="<?= @$info->en_witness_date?>"/></td>
        </tr>
        <tr class="even">
            <td colspan="7">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
    </tbody>
	</table>
<!-- table end -->
</form>

			</div>
		</div>
		
		<?=$this->load->view('include_sidebar',array('id'=>$id,'forms'=>$forms))?>
	</div>

<script type="text/javascript">
$().ready(function() {
  $("#form").validate({
    rules: {
		cn_app_type:"required",
		en_app_type:"required",
		cn_r1_c4:"required",
		en_r1_c4:"required",
		cn_applicant_date:"required",
		en_applicant_date:"required",
		cn_witness_date:"required",
		en_witness_date:"required"
    }
  });
  
	$.datepicker.setDefaults(
		{
		dateFormat: 'dd-mm-yy',
		changeMonth: true,
		changeYear: true,
		showOn: "both",
		buttonImage: "images/calendar.gif",
		buttonImageOnly: true
		}
	);

	$("#cn_r1_c3").datepicker();
	$("#cn_r1_c6").datepicker();
	$("#cn_r2_c3").datepicker();
	$("#cn_r2_c6").datepicker();
	$("#cn_r3_c3").datepicker();
	$("#cn_r3_c6").datepicker();
	$("#cn_r4_c3").datepicker();
	$("#cn_r4_c6").datepicker();
	$("#cn_r5_c3").datepicker();
	$("#cn_r5_c6").datepicker();
	$("#cn_r6_c3").datepicker();
	$("#cn_r6_c6").datepicker();
	$("#cn_r7_c3").datepicker();
	$("#cn_r7_c6").datepicker();
	$("#cn_r8_c3").datepicker();
	$("#cn_r8_c6").datepicker();
	$("#cn_r9_c3").datepicker();
	$("#cn_r9_c6").datepicker();
	$("#cn_r10_c3").datepicker();
	$("#cn_r10_c6").datepicker();
	$("#cn_r11_c3").datepicker();
	$("#cn_r11_c6").datepicker();
	$("#cn_applicant_date").datepicker();
	$("#cn_witness_date").datepicker();
	
	$("#en_r1_c3").datepicker();
	$("#en_r1_c6").datepicker();
	$("#en_r2_c3").datepicker();
	$("#en_r2_c6").datepicker();
	$("#en_r3_c3").datepicker();
	$("#en_r3_c6").datepicker();
	$("#en_r4_c3").datepicker();
	$("#en_r4_c6").datepicker();
	$("#en_r5_c3").datepicker();
	$("#en_r5_c6").datepicker();
	$("#en_r6_c3").datepicker();
	$("#en_r6_c6").datepicker();
	$("#en_r7_c3").datepicker();
	$("#en_r7_c6").datepicker();
	$("#en_r8_c3").datepicker();
	$("#en_r8_c6").datepicker();
	$("#en_r9_c3").datepicker();
	$("#en_r9_c6").datepicker();
	$("#en_r10_c3").datepicker();
	$("#en_r10_c6").datepicker();
	$("#en_r11_c3").datepicker();
	$("#en_r11_c6").datepicker();
	$("#en_applicant_date").datepicker();
	$("#en_witness_date").datepicker();
	
	$("#printInfo").click(function(o) {
		var prints = [
			{rel_id: <?=$cateid?>, rec_id: <?=$id?>}
		]  ;
		
		var jdata = JSON.stringify(prints);
		//alert(jdata);
		$.post("<?=site_url('proxy/does/'.str_replace('==','',base64_encode('http://'.$_SERVER['SERVER_NAME'].':9090/javaprduct/servlet/test')))?>",{clients:jdata},function(msg){alert(msg)});
	});
	
	$("#printInfo").ajaxError(function(event,request, settings){
		//$(this).append("<li>出错页面:" + settings.url + "</li>");
		alert("无法访问"+ settings.url );
	}); 
 
});
</script>

<?=$this->load->view('include_footer',null)?>